Live Surgery Highlights ASE

NATIONAL HARBOR, Md. -- For the first time ever, there was a live surgical broadcast at the annual meeting of the American Society of Echocardiography.

For this historical event, ASE officials chose to highlight a transcatheter aortic valve implantation (TAVI) procedure and the important role that echocardiography plays in it, according to Sherif F. Nagueh, MD, from the Methodist Hospital in Houston and the program chair for this year's ASE meeting.

"Many of our members will be seeing more and more patients whose valves will be or have been replaced percutaneously. We wanted to offer them the chance to see an actual case and to observe the role of imaging before, during, and after the intervention," Nagueh told MedPage Today.

The case, which was transmitted from Washington Hospital Center in Washington, D.C., had an imaging team headed by Steven A. Goldstein, MD, that used 2D transthoracic echo and 3D transesophageal echo. Attendees were particularly interested in how best to determine the size of the valve. They also were keen to know why paravalvular leaks occur and how one knows whether they merit observation or action, Nagueh said.

He also highlighted a multimodality symposium that covered diseases of the aorta, myocardium, pericardium, and coronary arteries. This effort, jointly sponsored by the American Society of Nuclear Medicine, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography, detailed how and when the different imaging techniques could be used.

"The unique approach to this session was that it was disease-based in that we showed how each imaging modality could offer potential answers to a particular clinical question," Nagueh said. "We have to be prepared to do the best we can with the resources we have, while following evidence-based medicine."

Nagueh also said he was impressed with the preclinical studies submitted and presented at the meeting. The winner in the Young Investigator category, for example, showed how the use of ultrasound helps deliver a protein that decreases the likelihood of cell death following chemotherapy.

Another study in the early stages of human testing showed that an echo technique called integrated backscatter can help predict the amount of tissue loss after a myocardial infarction. "The integrated backscatter is a measure of the amplitude of ultrasound signals coming from a particular tissue. Certain values indicate heart damage," Nagueh said.

A study involving ultrasound contrast agents has immediate practical value, he said. Researchers showed that when echo images are suboptimal, the use of IV echo contrast improves the accuracy of ventricular volume measurements and of the ejection fraction when compared with cardiac MRI, the gold standard.

The meeting would not have been complete without a session on practice management, particularly in light of the Supreme Court's ruling that the Affordable Care Act (ACA) is constitutional. Like all medical specialties, cardiologists and echocardiographers will be affected by the influx of millions more patients into the healthcare system once the ACA takes hold.

"Echocardiography could see a rise in popularity, given that it's relatively inexpensive compared with other cardiac imaging modalities and that it provides both anatomical and functional cardiac data," Nagueh said.

The ACA also provides an opportunity for a focus on prevention. Nagueh said that echo is excellent for detecting subclinical disease. "If we can identify these patients earlier in their disease process, we could perhaps target their prevention efforts more aggressively. This in turn might give the patients the impetus to pursue preventive efforts more faithfully," he concluded.

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